There are now many excellent compilations on the subject. Let’s start with a review, published in the highly regarded Cochrane Database Reviews on the National Center for Biotechnology Information’s Website. The citation is Scheiman M, Gwiazda J, Li T. Non-surgical interventions for convergence insufficiency. Cochrane Database Syst Rev 2011 Mar 16;(3):CD006768.
Office-based vision therapy is far superior to any other form of intervention
Convergence insufficiency, or CI, is a condition for which research has proven that office-based vision therapy is far superior to any other form of intervention. Two important points to keep in mind about this gold standard study, the citation for which is as follows:
Scheiman M, Cotter S, Mitchell GL, Kulp M, et al (CITT Study Group). Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. Arch Ophthalmol 2008;126:1336-49.
- A successful or improved outcome was found in 73% of the office-based therapy group, 43% of the pencil push-up group, and 35% of the office-based placebo therapy group, and 33% of the home-based computerized therapy group.
- The results of this study are now being used by some insurance carriers to support the need for office-based vision therapy, but only of 12 weeks duration, as was used in the CITT study.
This demonstrates several very significant points about research on optometric vision therapy:
- Unlike drug studies, in which the patient takes a placebo pill, it is challenging to design a placebo therapy group. Placebo therapy must be designed well enough that neither the patient nor the therapist knows that the therapy is not directly addressing the condition. The CITT group did a brilliant job designing this group, which is why they were able to generate such a good rate of improvement that came about from improving sustained visual attention – in fact, a couple of percentage points greater than the home-based computerized therapy group!
- Although the outcome after 12 weeks of therapy was impressive at a 73% rate of improvement, we do not settle for that in our practice. Why would you want only a 73% rate of improvement if by going beyond 12 weeks, and/or adding additional procedures, you can generate a 95% rate of improvement?
- Even if we take what the CITT has proven at face value, since ophthalmologists and pediatricians profess to practice only evidence-based medicine, that means that in the years since the CITT was published the field should have been transformed and have integrated the research outcomes of the CITT. Unfortunately for many patients in need, almost no pediatric ophthalmologists prescribe office-based vision therapy.